Thrombolytic therapy is an important modality in the treatment of patients with peripheral arterial and venous thrombosis. Randomized clinical trials have compared thrombolytic therapy with traditional surgical options, thus providing guidelines for patient selection. As a therapeutic intervention, lytic therapy…
Despite the focus on operative and endovascular interventions in vascular surgery, most patients with chronic lower extremity ischemia do not require surgical intervention. Nonoperative therapy and risk factor modification remain the primary components of management for the majority of patients.…
Introduction To many physicians, the diagnosis and management of thoracic outlet syndrome (TOS) is confusing. Part of the confusion arises because TOS is a term applied to three distinct clinical entities, which may share common anatomical elements yet may present…
Minimally invasive endoscopic technology has rapidly transformed both thoracic and abdominal surgery, and the field of surgical sympathectomies is no exception. For thoracic sympathectomy, the thoracoscopic procedure is used almost exclusively. Laparoscopic and retroperitoneoscopic techniques have also been developed for…
Endovascular therapy (EVT) has increasingly become the initial clinical option for treating both claudication and critical limb ischemia (CLI). Similar to the evolution of open bypass surgery, EVT began above the knee and has been progressively extended to the infrapopliteal…
Management of infrainguinal arterial occlusive disease continues to move away from open surgery and toward percutaneous procedures, and the number of percutaneous options is growing rapidly. This chapter focuses on standard techniques for arterial access, diagnostic imaging, lesion crossing, and…
Open vein harvest (OVH) for coronary artery bypass grafting (CABG) and infrainguinal bypass procedures is associated with increased patient morbidity and postoperative wound complications. In the limb salvage population, patients exhibit severe peripheral arterial occlusive disease, marginal distal perfusion, poor…
This chapter discusses open surgical options for femoral, popliteal, and tibial arterial occlusive disease. Although some of these procedures may also be performed for disabling intermittent claudication, the vast majority should only be performed for critical lower limb ischemia, which…
Mesenteric Arterial Disease Chronic mesenteric ischemia (CMI) is an uncommon disorder, accounting for fewer than 1 per 100,000 hospital admissions in the United States. Since the first successful mesenteric endarterectomy by Shaw and Maynard in 1958, techniques of revascularization have…
Historical Background Renovascular Hypertension In 1934, Goldblatt demonstrated that constriction of the renal artery (renal artery stenosis [RAS]) produced atrophy of the kidney and hypertension in dogs. As a clinical pathologist, Goldblatt noticed that extensive vascular disease was often present…